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Uptake of practice-based commissioning is being hampered by PCT red tape and disinterest, say GPs.

Despite Government moves to incentivise practice participation via the quality framework (Pulse July 16), GPs believe the real solution lies in tackling PCT inertia and bureaucracy.

The Department of Health said informal evidence showed around a third of practices were 'involved' in the flagship scheme, but admitted it had no firm figures.

A Pulse snapshot survey suggests 'involvement' falls far short of active commissioning.

Dr Brian Balmer, secretary of Essex LMC, said the first year of practice-based commissioning was 'lost'.

He added: 'PCTs are not selling it. It's a missed opportunity. What is being asked of them is to take a risk on something new, which is like asking a cat to bark.'

He called on the Government to performance manage PCTs in a bid to force them to act. 'They are Daleks who must obey,' he said. 'If making them tick a box does the trick that's what should happen.'

Dr Stewart Findlay, PEC chair at Durham Dales PCT, said PCT targets could speed up the process. He was frustrated that even though his PCT was at an 'advanced' stage, commissioning would not begin until September at the earliest.

'I don't see how the current system could be quicker,' he said. 'It involves a lot of change and that takes time.'

Steve Mercer, Avon LMC chief executive, said commissioning was unlikely to begin in the area before next April because of its huge financial deficit.

In Surrey, GPs eager to get involved criticised trusts for delays in agreeing indicative budgets.

Dr Michael Taylor, chair of the Small Practices Association, said many members were enthusiastic about the initiative but finding the process 'ponderously slow'.

He added: 'The problem is not at a GP level. Maybe some sort of incentive to PCTs would help.

'One of the bottlenecks for GPs is having to explain what they will do with any savings and then the PCT has to approve that.'

Professor Chris Ham, a former Government health adviser, said uptake was patchy. 'PCTs have a lot on their plate,' he said.

How PCTs are holding up

practice-based commissioning

Surrey PCT delays in making indicative budgets

available; no GPs commissioning yet

Essex Trusts 'not selling' the scheme to

practices ­ little information or guidance;

no GPs commissioning yet

Avon Commissioning abandoned for a year as

PCTs battle huge debts

By Joe Lepper

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